Dentists in Malta are increasingly having to treat patients in agony because of complications following cosmetic procedures in Turkey, with victims of botched teeth work regretting travelling abroad for treatment.

Dubbed #TurkeyTeeth online, the trend of travelling outside Europe for cosmetic procedures at cheaper prices has gained popularity, with extensive social media advertising luring hundreds to Turkey to get a ‘perfect smile’ for a fraction of the price charged by dentists in Malta.

The most popular procedure is the fitting of crowns – tooth caps affixed to natural teeth after these are shaved down significantly, often leaving nothing of the tooth but tiny stubs. While the process is often marketed as simple and straightforward, the experience quickly turns sour if complications arise.

In some cases, the complications have been so severe, patients had no option but to seek treatment at Mater Dei Hospital, dentists said. Others were forced to return to Turkey for further treatment.

One patient, retiree Anthony Zammit, said screws to keep implants in place fell off soon after the procedure in Turkey. He has been unable to eat and close his mouth properly for over a year, and his teeth now feel “wobbly”.

“They cut corners… you can see it when you’re there and I experienced it. They told us the material used in the operation was German but upon closer inspection of the labels, we realised the products were actually from Korea,” he said.

I want to cry every single time I look in the mirror

Zammit also claims some local dentists are reluctant to treat patients with complications after travelling to Turkey and fears he has no other option but to travel back to the country.

Similarly, Mary Camilleri said she “rues the day” she decided to have the procedure in Izmir, south of Istanbul, after her crowns started chipping after three months. She is now left with a mouth full of “shattered teeth”.

“I want to cry every single time I look in the mirror,” she said.

Since the procedure in 2019, Camilleri has returned to Turkey in an attempt to fix the issue but after several trips, she has turned to a Maltese dentist for help.

“By the time I sort out the issue locally, the total cost will be more than the original price quoted by local dentists,” Camilleri said.

‘Excruciating pain… patient overdosed’

Dentists who spoke to Times of Malta described numerous instances where patients faced serious complications. One patient had to be rushed to Mater Dei after overdosing on painkillers which he took in an attempt to stop the “excruciating pain” from an infection after a procedure in Turkey. Another said a patient became “too depressed” after months undergoing additional treatment to fix issues from the initial procedure. 

Another patient had screws used to affix the implants “cut” to the required length, as opposed to having ones in the right size, causing serious infection. Screws come in different sizes to fit the various mouths and jaws.

Hospital sources said they have seen a spike in people at Mater Dei with infections that, upon further investigation, are linked to procedures carried out in Turkey.

Dentist Ann Meli Attard , who has a special interest in prosthodontics, aesthetic and restorative dentistry, said treatments offered in Turkey are often ones deemed a “last resort” in Malta and the rest of Europe.

Many patients, she said, do not actually require the type of invasive work carried out in Turkey and can often still achieve a “perfect smile” with a series of simpler, and at times cheaper, procedures.

Most patients travelling to Turkey are young – in their 20s and 30s – and are often coming back to Malta with full sets of crowns that cover all their teeth. In many of these cases, the crowns are being fabricated ‘stuck together’, making it difficult for patients to keep them clean. 

She described the case of a 21-year-old who only needed a few fillings, a small bridge and tooth whitening.

“The patient went to Turkey and came back with all his teeth covered in zirconia crowns. He was in severe pain because the treatment was carried out too quickly and also required three root canal treatments he did not need before going abroad. The damage caused to this patient’s dentition is permanent and irreversible. No dental surgeon trained in Malta would ever consider such a treatment plan in a healthy mouth,” Meli Attard said.

Other complications dentists have seen include dental nerve inflammation, which can cause severe pain and killing the nerve itself, as well as problems with jaw joints because of drastic change in bite patterns. Meli Attard said patients often describe this as being similar to labour pains. 

Treatments offered in Turkey are often ones deemed a last resort in Malta and the rest of Europe- Dentist Ann Meli Attard

 

The dentist said even in cases where such invasive work is indeed needed, she often puts in temporary prostheses to ensure the perfect fit, function and aesthetics, before fitting in permanent crowns. This process often takes weeks and sometimes months.

“This is not what happens in Turkey. Within a few days, patients are sent home and by the time they come to Malta, they would not have even healed properly,” said the dentist, who also lectures at the University of Malta and is part of the Dental Association of Malta’s executive committee.

Implant surgeon Nicholas Busuttil Dougall, also on the committee, echoed Meli Attard’s concerns, especially after the number of patients he sees with complications after trips to Turkey spiked in recent months.

“We had a patient who had to be sent to hospital because he overdosed on painkillers. We had a patient who was crying hysterically in pain. We treated the source of pain, however suggested she goes back to Turkey immediately because it was impossible to treat her here because we did not have the right tools matching the implants in her mouth. When the company arranging for patients to go up to Turkey was contacted, they tried to downplay the issue.

“It’s happening routinely. We had a couple of bad bridge (the false teeth which are attached to the implants) fractures. In one case, the bridge was changed three times in Turkey and the patient spent more money going back and forth than it would have cost them to do the work locally,” Busuttil Dougall said.

A number of patients, he said, also had implants that are not compatible with EU standards and so dentists locally were unable to service the work. Such invasive treatments require regular check-ups, with patients normally asked to visit their dentists at least once every six months.

All about the price

Patients who travel to Turkey have told their dentists they opted to do so because procedures are a fraction of the price they would have paid in Malta and the process is faster.

Adverts for clinics in Turkey shared on social media suggest implants start from as little as €200. According to Busuttil Dougall, this does not even cover the basic costs of the implant itself in Malta.

“So how can we match the prices in Turkey when the cost of a CE-marked implant is more than what they are charging? This, without taking into consideration other costs such as salaries and materials. In Malta, a restored dental implant (planning, surgery, post-op care, impressions and final prosthetic work which is usually a porcelain tooth) costs between €1,500 and €1,700. 

We are not afraid of competition… this is not competition. We are worried about our patients being overtreated and coming back with a lot of complications- Implant surgeon Nicholas Busuttil Dougall and dentist Ann Meli Attard

“This may also include bone grafting costs.  Treatment time is usually from four to six months, with constant recall visits during this period.  I cannot understand how a patient goes up once, spends a week and comes back to Malta ready.  It is simply incomprehensible,” he said.

Both Meli Attard and Busuttil Dougall said patients are being “overtreated with false promises” they will not need other dental treatment in the future.

They both vehemently denied that they were speaking out because they were losing business to clinics in Turkey.

“We are not afraid of competition… this is not competition. We are worried about our patients being overtreated and coming back with a lot of complications.  The cost of repairing these complications will end up being more than what they would have spent if treatment was done well in the first place.  We are also concerned about the pain and anguish and lifelong scarring the patients are subjected to,” Busuttil Dougall said.

Times of Malta has contacted Turkish clinics as well as the Turkish Dental Association for comments, but replies were not forthcoming.

Dentists wary of fixing #TurkeyTeeth

Times of Malta contacted 43 dentists for their views and asked them whether they would treat patients with complications following invasive cosmetic procedures carried out in Turkey.

The majority expressed reluctance at treating such patients, saying they would either refer them to Mater Dei if their condition was serious or else manage the acute pain or inflammation only.

“Shoddy work is simply untreatable and unfortunately often irreversible. End result is loss of teeth at a very young age. If you see extracting all irreversibly ruined teeth and providing dentures as a viable treatment, then yes. Patients at such a young age won’t accept this after all the money they spent. And rightly so. So, they’re better off facing the Turkish dentist,” one dentist said.

But in most cases, the dentists said the damage is “irreversible” and so there would be little or nothing that can be done.

“Diagnosing the problem is difficult when these patients have full mouth bridgework carried out. Treatment without a good diagnosis is not straightforward and at times impossible,” another said.

A number of dentists also feared they would be held liable if further complications arise after their attempt to treat their patient.

“Restoring the kind of atrocities we are seeing requires a lot of work, skill and money, and opens us up to huge medico-legal liabilities,” one said.

Duty to treat patients

Dentist Jean Paul Demajo, meanwhile, said he believed all patients should be treated, even if they had the work done in Turkey.

Estimating he sees an average of 15 patients per month with complications related to procedures carried out abroad, Demajo said he is happy to treat such patients.

“We have been doing dental tourism as a clinic for years, bringing people from other countries to Malta, so I am not alarmed by the travelling.” 

On claims that some dentists might not have the tools needed to work on materials used in Turkey, Demajo said a dentist should refer such patients to someone else.

A UK-registered specialist in periodontics, Edward Sammut, said young people are having unnecessary and overly invasive procedures to achieve results that could have easily been replicated using simpler, “more conservative, and less damaging methods” in Malta, often at similar overall costs.

He fears because the cosmetic work done is often “destructive and irreversible”, for those with complications, some may have no option but to resort to “extraction and dentures” in the future.

Engaging in remedial treatment is a “tricky proposition” and one complication can lead to another, but Sammut makes it clear to patients that he and his team are doing their best and cannot be held liable if further complications ensue.

“We invest a lot of time in carefully investigating and documenting everything before starting any remedial work, and obviously that comes at a cost for the patient,” Sammut said.

Medical professionals, including dentists, are banned from advertising their services in Malta in the same manner as those abroad. This means that patients are sometimes unaware they can get certain procedures done in Malta and assume they are only available in other countries.

“The Medical Council governs how a Maltese dentist can communicate with the public. To keep in line with the local rules, we cannot advertise on social media in the same way those from, for example, Turkey can. Even showcasing our own work can be viewed unfavourably, and posts which are aimed at impartial information could be interpreted as advertising.”

Longer implants shortened to fit the patient’s jaw.

Veneers vs crowns vs implants

Veneers are often the first option offered to patients as these consist of ultra-thin shells bonded to the teeth. Veneers only encase the front of the tooth, as opposed to crowns, which cover the entire tooth. Crowns are normally only used when the structural integrity of a tooth is in danger and therefore reinforcement is needed.

Trimming down the tooth would be required with both veneers and crowns, although for the latter, the teeth are shaved down much more.

Implants, on the other hand, are titanium screws surgically implanted into the jawbone and onto which a tooth or a bride can be attached. These are often used to replace missing teeth.

‘I had a great experience, I will go back any day’

For make-up artist and influencer Henry Galea, getting veneers in Turkey was the best decision he ever made, and he cannot imagine life without his new teeth.

Galea said he was interested in travelling to Turkey to get veneers after his friends came back with positive results.

“Of course, I have heard the stories like everyone else, but I did not have that experience with my clinic. I was almost given a crash course and was flooded with information even before I travelled there,” he said.

Galea spent a total of nine days in Turkey and had multiple “mock-ups” put in place before the permanent veneers were put in.

“The first few weren’t what I was after, so they kept trying until we had a mock-up that I liked. After that, my teeth were shaved, although only slightly, and then we waited a few days for healing.

“It took nine hours for the veneers to be applied and I had three dentists with me at all times. I felt safe throughout. After that, they spent two to three days monitoring me to make sure there were no complications and that I could eat and wasn’t in pain,” he said.

Admitting he has heard of stories of people experiencing complications, Galea said he even had friends calling him, concerned when they found out about his procedure.

People need to do proper research, he said, and not rely solely on social media adverts. They should also ask for documents and make sure the dentists are qualified.

While Galea says he has not had any problems since getting his veneers, he noted with disappointment that some dentists seem reluctant to treat patients who have been to Turkey.

“If there are complications, I get it. But if all is well and it’s just a normal check-up, why shouldn’t they see us?” he asked.